Restrictions to Comprehensive Reproductive Health Care

Restrictions to Comprehensive
Reproductive Health Care
Position Statement
The American College of Obstetricians and Gynecologists and
The American Congress of Obstetricians and Gynecologists
Excellence in women’s health care is an essential element of the long-term physical,
intellectual, social, and economic well-being of any society 1. The American College of
Obstetricians and Gynecologists and the American Congress of Obstetricians and
Gynecologists (ACOG) continue to support efforts to improve the dignity, autonomy,
rights, and health of women in the United States and globally 2. ACOG is concerned that
a growing number of U.S. health care systems and hospitals limit the scope of
reproductive health care services that they provide. Because of hospital mergers and
acquisitions, some communities lack any alternatives to hospitals that prohibit certain
essential reproductive health services.
ACOG recognizes that access to comprehensive reproductive health care services is
essential to women’s health and well-being. Women should have access to scientifically
based health care. Prohibitions on essential care that are based on religious or other
non-scientific grounds can jeopardize women’s health and safety.
Restrictive hospital policies can damage the patient–physician relationship. In some
instances, physicians are prohibited from informing patients about treatment options
that are not permitted at the hospital, depriving patients of valuable information and the
option of going elsewhere for treatment (if alternatives exist in the community).
Moreover, in some hospitals, even certain emergency treatments are prohibited, such
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1 American College of Obstetricians and Gynecologists. Access to women's health care.
Statement of Policy. Washington, DC: American College of Obstetricians and Gynecologists;
2013.
2 American College of Obstetricians and Gynecologists. Global women's health and rights.
Statement of Policy. Washington, DC: American College of Obstetricians and Gynecologists;
2015.
The American College of Obstetricians and Gynecologists
The American Congress of Obstetricians and Gynecologists
409 12th Street, SW • PO Box 96920 • Washington, DC 20090-6920 • Telephone 202-638-5577
Restrictions to Comprehensive Reproductive Health Care
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as emergency contraception and treatment of ectopic pregnancy 3, 4. Where
reproductive health care services are prohibited, health care providers are put in the
difficult position of having to withhold needed care until patients’ conditions deteriorate
to a point at which care is permitted. Ultimately, the health of women and quality of the
patient–physician relationship suffer.
ACOG recognizes that access to health care services (including, but not limited to,
options for the appropriate management of miscarriage, ectopic pregnancy, infertility,
pregnancy termination, sterilization, and contraceptive methods) is in the best interest of
women, their families, and their communities. If hospital mergers, federal, state and
local legislation, hospital policies, and/or business-related decisions threaten to create
restrictive institutional circumstances for patients and clinicians, ACOG suggests that
the obstetrician-gynecologist consider the following responses:
• Stay involved in hospital and political leadership in the community.
• Work to ensure that comprehensive reproductive health care remains available
within communities.
• Continue to include women’s health advocacy-related educational topics and
clinical competencies in residency curriculum.
• Report poor patient outcomes and harms that result from limitations in care.
It is best to maintain the availability of care within a community, so that women who
need care have alternatives to hospitals where it is restricted. Some localities have
devised creative approaches to pending mergers, such as splitting off reproductive
health services into a separate business entity before the merger occurs 5, 6. If no such
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3 Freedman LR, Stulberg DB. Conflicts in care for obstetric complications in Catholic hospitals.
AJOB Primary Research 2013;4(4):1-10.
4 National Health Law Program. Health care refusals: undermining quality care for women. Los
Angeles (CA): NHeLP; 2010. Available at: http://www.healthlaw.org/publications/health-carerefusals-
undermining-care-for-women - .VxZOVvkrLcs. Retrieved April 21, 2016.
5 Uttley L, Reynertson S, Pawelko R, Law SA, Hasbrouck P, Gottschalk K. Merging Catholic and
non-sectarian hospitals: NYS models for addressing the ethical challenges. New York (NY):
MergerWatch; 2013. Available at:
http://static1.1.sqspcdn.com/static/f/816571/23042588/1372882137057/Models+of+Catholicsecular+
hospitals+mergers+in+NYS.pdf?token=JKbP2Du6uWM%2BLtV7iZI49K36Qx8%3D.
Retrieved April 21, 2016.
6 MergerWatch. Working with the community: hospital merger compromises that protect
patients. New York (NY): MergerWatch; 2005. Available at:
http://static1.1.sqspcdn.com/static/f/816571/11901657/1303759416977/ch_compromises.pdf?to
ken=RdLK1kYMwObtwpUNscSAWHLIAbw=. Retrieved April 21, 2016.
Restrictions to Comprehensive Reproductive Health Care
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solution can be found, and insufficient care or restrictive options for care are provided,
or appropriate care is withheld, the accrediting body of the institution can be contacted.
For inpatient facilities, this may include the state regulatory agency, DNV GL (an
accrediting organization for hospitals), the Joint Commission, or another accrediting
body. For outpatient facilities, this may include the state regulatory agency,
Accreditation Association for Ambulatory Health Care, the American Association for
Accreditation of Ambulatory Surgical Facilities, the Joint Commission, or another
accrediting body.
In addition to reporting insufficient, withheld, or restrictive care, health care providers
should strive to identify resources and alternative solutions to maximize the available
health care options for patients. Alternative solutions may include referring patients to
other health care systems or clinicians capable of providing the full range of health care
options or identifying a regional “network” of facilities or health care providers not
subject to care restrictions whose information can be made available to patients.
Approved by the Executive Board: April 2016
Revised: April 2016